<%-- 
    Document   : index
    Created on : Jan 2, 2012, 2:56:59 PM
    Author     : user
--%>

<%@page contentType="text/html" pageEncoding="UTF-8"%>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
   "http://www.w3.org/TR/html4/loose.dtd">

<%@include file="../jspf/header.jspf" %>

<div style="width: 100%">
<p class="pageTitle"><strong>Creati un cont nou </strong>| Detaliile
profilului</p>
<br />
<p class="txt1">Formularul de mai jos va permite sa va inregistrati la
VisionAlarm.ro. <br />
Campurile marcate cu * sunt obligatorii.<br />
<br />
</p>

<%@include file="../jspf/message.jspf" %>

<form id="signupForm" name="signupForm"
	action="customers?action=add" method="post" >

<div class="divReg">
<div class="txt1" style="width: 100%"><b>Informatii personale</b>
<hr />
</div>
<table class="tableInfo txt3">
	<tr>
		<td class="tableInfo c1"><label for="firstname"><b>Nume<b /></label></td>
		<td style="width: 3%; text-align: center;" class="style1">*</td>
		<td class="tableInfo c3"><input type="text" id="firstname"
			name="firstname" size="32" maxlength="32" value="" /></td>
	</tr>
	<tr>
		<td class="tableInfo c1"><label for="lastname"><b>Prenume<b /></label></td>
		<td style="width: 3%; text-align: center;" class="style1">*</td>
		<td class="tableInfo c3"><input type="text" id="lastname"
			name="lastname" size="32" maxlength="32" value="" /></td>
	</tr>
</table>
</div>
<div class="divReg">
<div class="txt1" style="width: 100%"><b>Nume utilizator si Parola</b>
<hr />
</div>
<table class="tableInfo txt3">
	<tr>
		<td class="tableInfo c1"><label for="username"><b>Username<b /></label></td>
		<td class="tableInfo c2">*</td>
		<td class="tableInfo c3"><input type="text" id="username"
			name="username" size="32" maxlength="100" value="" /></td>
	</tr>
	<tr>
		<td class="tableInfo c1"><label for="password"><b>Parola<b /></label></td>
		<td class="tableInfo c2">*</td>
		<td class="tableInfo c3"><input type="password" id="password"
			name="password" size="32" maxlength="100" value="" /></td>
	</tr>
	<tr>
		<td class="tableInfo c1"><label for="confirm_password"><b>Confirma
		Parola<b /></label></td>
		<td class="tableInfo c2">*</td>
		<td class="tableInfo c3"><input type="password" id="confirm_password"
			name="confirm_password" size="32" maxlength="100" value="" /></td>
	</tr>
</table>
</div>
<div class="divReg">
<div class="txt1" style="width: 100%"><b>Adresa de facturare</b>
<hr />
</div>
<table class="tableInfo txt3">
	<tr>
		<td class="tableInfo c1"><label for="address"><b>Adresa<b /></label></td>
		<td class="tableInfo c2"></td>
		<td class="tableInfo c3"><input type="text" id="address"
			name="address" size="32" maxlength="100" value="" /></td>
	</tr>
	<tr>
		<td class="tableInfo c1"><label for="city"><b>Oras<b /></label></td>
		<td class="tableInfo c2"></td>
		<td class="tableInfo c3"><input type="text" id="city" name="city"
			size="32" maxlength="32" value="" /></td>
	</tr>
	<tr>
		<td class="tableInfo c1"><label for="district"><b>Judet/Sector<b /></label></td>
		<td class="tableInfo c2"></td>
		<td class="tableInfo c3"><input type="text" id="district"
			name="district" size="32" maxlength="32" value="" /></td>
	</tr>
	<tr>
		<td class="tableInfo c1"><label for="postalCode"><b>Cod Postal<b /></label></td>
		<td class="tableInfo c2"></td>
		<td class="tableInfo c3"><input type="text" id="postalCode"
			name="postalCode" size="32" maxlength="32" value="" /></td>
	</tr>
</table>
</div>
<div class="divReg">
<div class="txt1" style="width: 100%"><b>Informatii de contact</b>
<hr />
</div>
<table class="tableInfo txt3">
	<tr>
		<td class="tableInfo c1"><label for="phone"><b>Telefon<b /></label></td>
		<td class="tableInfo c2"></td>
		<td class="tableInfo c3"><input type="text" id="phone" name="phone"
			size="32" maxlength="100" value="" /></td>
	</tr>
	<tr>
		<td class="tableInfo c1"><label for="Fax"><b>Fax<b /></label></td>
		<td class="tableInfo c2"></td>
		<td class="tableInfo c3"><input type="text" id="fax" name="fax"
			size="32" maxlength="100" value="" /></td>
	</tr>
	<tr>
		<td class="tableInfo c1"><label for="email"><b>Email<b /></label></td>
		<td class="tableInfo c2">*</td>
		<td class="tableInfo c3"><input type="text" id="email" name="email"
			size="32" maxlength="100" value="" /></td>
	</tr>
	<tr>
		<td class="tableInfo" colspan="3" >
		<div style="margin-top:15px">
		<label
			for="agree"><b>Sunt de acord cu <a href="index?action=politica" class="txt2"><b>Termeni si
		Conditii</b></a><b /></label> <input type="checkbox" class="checkbox"
			id="agree" name="agree" />

			</div>
			</td>

	</tr>
</table>
</div>
<div class="divReg txt2">
<div>
<button id="aplica" name="aplica" title="Aplica" class="button">Aplica</button>
</div>
<div><br />
&nbsp; Recomandari<br />
&nbsp;Parola trebuie sa fie diferita de numele de utilizator. Va
recomandam sa folositi o parola cu o marime mai mare de 5 caractere. <br />
&nbsp; Adresa de e-mail trebuie sa fie functionala. Vom folosi aceasta
adresa pentru a comunica cu dumneavoastra. Din aceasta cauza, pentru a
putea folosi serviciile noastre este esential sa introduceti o adresa de
e-mail valida. <br />
&nbsp;Toate informatiile introduse de dumneavoastra sunt confidentiale.
<br />
Mai multe detalii puteti citi la la <a href="index?action=politica" class="txt2"><strong>
Termeni si Conditii</strong></a></div>
</div>
</form>

</div>
<%@include file="../jspf/footer.jspf" %>
